Regular aerobic exercise has many physiological and psychological benefits associated with healthy aging in the geriatric client. As more older adults seek to improve or maintain their fitness level throughout the lifespan, physical therapists need to understand what activities qualify as aerobic exercise, what current aerobic exercise guidelines are, and what special considerations for aerobic exercise to take into account when working with older adult populations.
Objectives:
The objectives of this page are to:
Examine the benefits of aerobic exercise for older adult populations
Determine what activities qualify as aerobic exercise
Review current recommendations of aerobic exercise parameters for older adults
Understand special considerations in older adult populations when developing aerobic exercise recommendations
Benefits of Aerobic Exercise
There are many benefits of aerobic exercise in older adult populations. According to the American College of Sports Medicine (ACSM), older adults can adapt to regular aerobic training as well as younger adults by achieving a 10-30% increase in VO2 max in response with endurance training.1 Moderate levels of aerobic exercise may prevent age-related brain and cognitive decline, in addition to potentially reversing cognitive deterioration already present in older adults.2 Aerobic exercise has also been shown to reduce serum levels of inflammatory mediators IL-6, IL-18, and CRP. Elevated levels of these inflammatory markers are associated with multiple diseases such as atherosclerosis, coronary artery disease, hypertension, Type II diabetes, and congestive heart failure.3 Aerobic exercise has additionally been shown to improve sleep quality and duration in older adults with chronic insomnia.4
Activities that qualify as aerobic exercise
ACSM defines aerobic exercise as an activity “that uses the large muscles of the body in a continuous, rhythmical fashion, and that is relatively easy to maintain at a consistent intensity.”5 The Centers for Disease Control (CDC) lists aerobic activities based on intensity level (moderate vs. vigorous). Moderate-intensity is considered to be in the 5-6 range on a 10-point scale, where sitting is 0 and working as hard as you can is 10. Vigorous-intensity is in the 7-8 range on a 10-point scale.6 It is important to consider the patient's interest when determining what aerobic activities to recommend. Patient engagement in activities is likely to improve compliance in performing regular aerobic exercise. See the chart below (taken from the CDC website7) for a list of aerobic activity suggestions.
Moderate Intensity
Vigorous Intensity
Walking briskly (3 miles per hour or faster, but not race-walking)
Water aerobics
Bicycling slower than 10 miles per hour
Tennis (doubles)
Ballroom dancing
General gardening
Race walking, jogging, or running
Swimming laps
Tennis (singles)
Aerobic dancing
Bicycling 10 miles per hour or faster
Jumping rope
Heavy gardening (continuous digging or hoeing)
Hiking uphill or with a heavy backpack
The Go4Life website is sponsored by the National Institute on Aging at NIH. This resource is useful for older adults who want more aerobic exercise ideas. It also includes resistance, flexibility, and balance exercises that can safely be performed by older adults. The website link can be found here: https://go4life.nia.nih.gov/.
Current Guidelines for Aerobic Exercise Recommendations CDC, American Heart Association (AHA), & ACSM Guidelines6,8:
150 minutes of moderate-intensity aerobic activity every week
OR
75 minutes of vigorous-intensity aerobic activity every week
OR
An equivalent mix of moderate and vigorous intensity aerobic activity
Exercise must be done in minimum of 10 minute bouts in order to see benefits. For even more health benefits, double the amount of time per week of the above recommendations.
Special Considerations in Older Adult Populations
Fall screening and prevention are essential to perform when working with geriatric patients. The older adult patient should be screened for fall risk prior to any exercise recommendations. The ACSM and CDC recommend that “to reduce risk of injury from falls, community-dwelling older adults with substantial risk of falls (e.g., with frequent falls or mobility problems) should perform exercises that maintain or improve balance.”8 If the older adult is determined to have balance deficits, it does not mean they cannot participate in aerobic exercise. It is essential that they still participate in appropriate aerobic activities; however, the physical therapist must also prescribe balance exercises.
There are a number of physiological, psychological, and environmental concerns that must also be taken into account when recommending aerobic activities for older adults. Many chronic conditions such as COPD, cardiovascular disease, and obesity exist in the geriatric population. Patients with these conditions must be educated on their condition and how they can safely participate in aerobic exercise. There are also normal physiological changes with aging that must be considered when educating the patient on starting an aerobic exercise regimen. The ACSM has multiple resources available to guide the physical therapist in determining safe exercise recommendations for older adults requiring specific considerations:
Older adults should be screened for fall risk prior to developing exercise program.
Determine what special considerations may need to be taken into account when developing aerobic exercise recommendations. Use resources listed above to help guide recommendations for these patients.
Incorporate aerobic activities that are of interest to the older adult in exercise recommendations in order to promote compliance.
Educate patient on ACSM/CDC aerobic exercise recommendations and how they may safely and effectively incorporate these recommendations into their weekly routine.
Refer patient to additional resources for more information and exercise ideas.
References: 1. Mazzeo RS. Exercise and the older adult.https://www.acsm.org/docs/current-comments/exerciseandtheolderadult.pdf. Accessed June 4th, 2016. 2. Erickson KI, Kramer AF. Aerobic exercise effects on cognitive and neural plasticity in older adults. Br J Sports Med. 2009;43(1):22-24. 3. Kohut ML, McCann DA, Russell DW, et al. Aerobic exercise, but not flexibility/resistance exercise, reduces serum IL-18, CRP, and IL-6 independent of beta-blockers, BMI, and psychosocial factors in older adults. Brain Behav Immun. 2006;20(3):201-209. 4. Reid KJ, Baron KG, Lu B, Naylor E, Wolfe L, Zee PC. Aerobic exercise improves self-reported sleep and quality of life in older adults with insomnia. Sleep Med. 2010;11(9):934-940. 5. Kravitz L, Vella CA. Energy expenditure in different modes of exercise.http://www.acsm.org/docs/current-comments/energyexpendindifferentexmodes.pdf?sfvrsn=4. Accessed July 4th, 2016. 6. Centers for Disease Control and Prevention. How much physical activity do older adults need?. http://www.cdc.gov/physicalactivity/basics/older_adults/index.htm. Updated June 4, 2015. Accessed July 4th, 2016. 7. Centers for Disease Control and Prevention. Measuring physical activity intensity.http://www.cdc.gov/physicalactivity/basics/measuring/index.html. Updated June 4, 2015. Accessed July 4th, 2016. 8. Garber CE, Blissmer B, Deschenes MR, et al. American college of sports medicine position stand. quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: Guidance for prescribing exercise. Med Sci Sports Exerc. 2011;43(7):1334-1359.
Objectives:
The objectives of this page are to:
Benefits of Aerobic Exercise
There are many benefits of aerobic exercise in older adult populations. According to the American College of Sports Medicine (ACSM), older adults can adapt to regular aerobic training as well as younger adults by achieving a 10-30% increase in VO2 max in response with endurance training.1 Moderate levels of aerobic exercise may prevent age-related brain and cognitive decline, in addition to potentially reversing cognitive deterioration already present in older adults.2 Aerobic exercise has also been shown to reduce serum levels of inflammatory mediators IL-6, IL-18, and CRP. Elevated levels of these inflammatory markers are associated with multiple diseases such as atherosclerosis, coronary artery disease, hypertension, Type II diabetes, and congestive heart failure.3 Aerobic exercise has additionally been shown to improve sleep quality and duration in older adults with chronic insomnia.4
Activities that qualify as aerobic exercise
ACSM defines aerobic exercise as an activity “that uses the large muscles of the body in a continuous, rhythmical fashion, and that is relatively easy to maintain at a consistent intensity.”5 The Centers for Disease Control (CDC) lists aerobic activities based on intensity level (moderate vs. vigorous). Moderate-intensity is considered to be in the 5-6 range on a 10-point scale, where sitting is 0 and working as hard as you can is 10. Vigorous-intensity is in the 7-8 range on a 10-point scale.6 It is important to consider the patient's interest when determining what aerobic activities to recommend. Patient engagement in activities is likely to improve compliance in performing regular aerobic exercise. See the chart below (taken from the CDC website7) for a list of aerobic activity suggestions.
Current Guidelines for Aerobic Exercise Recommendations
CDC, American Heart Association (AHA), & ACSM Guidelines6,8:
- 150 minutes of moderate-intensity aerobic activity every week
OR- 75 minutes of vigorous-intensity aerobic activity every week
ORExercise must be done in minimum of 10 minute bouts in order to see benefits. For even more health benefits, double the amount of time per week of the above recommendations.
Special Considerations in Older Adult Populations
Fall screening and prevention are essential to perform when working with geriatric patients. The older adult patient should be screened for fall risk prior to any exercise recommendations. The ACSM and CDC recommend that “to reduce risk of injury from falls, community-dwelling older adults with substantial risk of falls (e.g., with frequent falls or mobility problems) should perform exercises that maintain or improve balance.”8 If the older adult is determined to have balance deficits, it does not mean they cannot participate in aerobic exercise. It is essential that they still participate in appropriate aerobic activities; however, the physical therapist must also prescribe balance exercises.
There are a number of physiological, psychological, and environmental concerns that must also be taken into account when recommending aerobic activities for older adults. Many chronic conditions such as COPD, cardiovascular disease, and obesity exist in the geriatric population. Patients with these conditions must be educated on their condition and how they can safely participate in aerobic exercise. There are also normal physiological changes with aging that must be considered when educating the patient on starting an aerobic exercise regimen. The ACSM has multiple resources available to guide the physical therapist in determining safe exercise recommendations for older adults requiring specific considerations:
Summary:
References:
1. Mazzeo RS. Exercise and the older adult. https://www.acsm.org/docs/current-comments/exerciseandtheolderadult.pdf. Accessed June 4th, 2016.
2. Erickson KI, Kramer AF. Aerobic exercise effects on cognitive and neural plasticity in older adults. Br J Sports Med. 2009;43(1):22-24.
3. Kohut ML, McCann DA, Russell DW, et al. Aerobic exercise, but not flexibility/resistance exercise, reduces serum IL-18, CRP, and IL-6 independent of beta-blockers, BMI, and psychosocial factors in older adults. Brain Behav Immun. 2006;20(3):201-209.
4. Reid KJ, Baron KG, Lu B, Naylor E, Wolfe L, Zee PC. Aerobic exercise improves self-reported sleep and quality of life in older adults with insomnia. Sleep Med. 2010;11(9):934-940.
5. Kravitz L, Vella CA. Energy expenditure in different modes of exercise. http://www.acsm.org/docs/current-comments/energyexpendindifferentexmodes.pdf?sfvrsn=4. Accessed July 4th, 2016.
6. Centers for Disease Control and Prevention. How much physical activity do older adults need?. http://www.cdc.gov/physicalactivity/basics/older_adults/index.htm. Updated June 4, 2015. Accessed July 4th, 2016.
7. Centers for Disease Control and Prevention. Measuring physical activity intensity. http://www.cdc.gov/physicalactivity/basics/measuring/index.html. Updated June 4, 2015. Accessed July 4th, 2016.
8. Garber CE, Blissmer B, Deschenes MR, et al. American college of sports medicine position stand. quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: Guidance for prescribing exercise. Med Sci Sports Exerc. 2011;43(7):1334-1359.